One of the critical questions to ask
when reading a medical journal article is
who funded the study?
In most journals,
researchers are required toidentify their sources of funding.
So what’s the problem?
Well,researchers can obscurethe true origin of financial support:
they can hide it, disguise it,
or even launder the money through a front group.
Case in point,
a study downplaying the risk of lung cancer
funded in part by the Foundation for Lung Cancer Early Detection, Prevention,and Treatment.
That doesn’t sound so bad
until you realize
it’s underwritten by millions from a tobacco company.
See, there’s no obligation to… to disclose
a funding source’s source of funding,
This allows companies to evade financial disclosure requirements,
and make it harder to follow the money trail.
Why does the funding source matter?
Every single one of eight reviews covering over a thousand studies
found that research funded by industry
is more likely to make conclusions that are favorable to industry.
why do some review articles on the health effects of second hand smoke
reach different conclusions than others?
The only factor was whether an author was affiliated with the tobacco industry.
This is a disturbing finding!
It suggests that,
far from conflict of interest being unimportant
in the objective and pure world of science.
It may be the main factor determining the result of many studies.
Not that you’d know because 77% of authors failed to disclose the sources of funding.
And that’s another problem:
the responsibility to disclose funding sources is left entirely up to the authors,
so how many researchers divulge the truth?
Evidently a law was passed in Denmark
requiring physicians to register any time they worked with industry,
which allowed researchers to cross-reference the studies they published
to see how honest they were.
And 48 % of the time,
the conflicts of interest were not disclosed
reinforcing the perception that
physicians simply don’t take conflict of interest seriously,
or at least Danish physicians.
What about the US?
We didn’t know
until this study was published.
Historically, there have been no means of confirmation or verification
when an American doctor said they had no conflicts of interest.
But then in 2007,
hip and knee replacement companies
were forced to pay hundreds of millions of dollars in fines
for giving orthopedic surgeons at illegal kickbacks.
Many orthopedic surgeons made decisions predicated on how much money they could make,
choosing which device to implant by going to the highest bidder.
“We expect doctors to make decisions based on what is in the best interests of their patients,”
said the Department of Justice, “not the best interests of their bank accounts.”
And part of the settlement
was that they would have to make public all the payments they made to physicians.
The release of those records offered a rare opportunity
to see if physicians were tellingthe truth on disclosure forms.
And…lo and behold, more than half of payments were not disclosed
totaling millions of dollars.
Now this was for surgeons and medical device companies.
What about doctors and drug companies?
The same thing happened where drug companies were forced to disclose
who they were paying off.
They looked at the publications of the doctors that got the most money,
at least 100 grand.
and they were worse than the surgeons.
In 69 % of the cases,
they fail to disclose their industry tie.
The problem is
that we just assume researchers are going to be honest and tell the truth.
But these findings suggest
that the accuracy and completenessof conflict-of-interest disclosures
can not be assumed.
So even when a paper says no conflict of interest,
who knows if it’s really true?
Long-time editor-in-chief of the New England Journal of Medicine
wrote a scathing piece on drug companies and doctors
who failed to disclose hundreds of thousands of dollars
from drug companies like Glaxo Smith Kline,
which had been fined literally billions of dollars
for things like bribes and suppressing data.
When they got results that werecommercially unacceptable,
they just buried them.
Billions in fines, but for drug companies
that may just be the cost of doing business.
As reprehensible as many drug industry practices are,
the medical profession may be even more culpable.
you expect drug companies to prioritize the bottom line,
we should expect more from the healing profession.